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Rev 2/23/2001 <br /> Page 6 of 6 <br /> � i <br /> Pt eparer t epresents that to the best of the Pt eparer's knowledge the above statements and facts are <br /> true and correct and to the best of the Preparer's actual knowledge no material facts have been <br /> a, suppressed or misstated <br /> r User's Signature Date <br /> Preparer's Signature Date <br /> to _ <br /> Respondant's Signature Date <br /> �1 <br /> e <br /> 9 <br /> i <br /> i <br /> h <br /> 42 <br /> e <br /> R O TormsTield rormsTSAMansactlon Screen Questionaire doe <br /> Fnttials <br />